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Objectives Oral function management has been recognized as important strategy for preventing postoperative complications. In this historical cohort study, we focused on the patients who planed gastrectomy, and investigated the appropriate duration and frequency of preoperative oral care to prevent complications after surgery. Methods Patients who planed surgery for gastric cancer between 2012 to 2018 were enrolled. We defined intensive oral care as initial intervention at least three weeks before surgery and follow-up intervention within a week before surgery. As the primary outcome, the incidence of postoperative infectious complications was compared between the intensive oral care and non- intensive oral care groups. Results A total of 576 patients were enrolled, including 66 with intensive oral care. The incidence of infectious complications was 2/66 (3.0%) in the intensive oral care group and 64/510 (12.5%) in the non-intensive oral care group. After adjusting for confounding factors, patients with intensive oral care exposure had a lower chance of developing postoperative infectious complications (Odds ratio; 0.217, 0.051-0.927). Conclusions Intensive oral care can help prevent postoperative infectious complications after gastrectomy. These findings suggest that appropriate preoperative oral care include at least two interventions: three weeks or more before and within one week before surgery.

A cross-sectional, nationwide survey was conducted in Japan to examine the relationship between tobacco smoking and oral diseases including implant failure. A questionnaire survey was sent to designated facilities by post, and 158 answered questions regarding implant loss. Smoking status, number of implant failures, and other related variables were collected from the participating dentists as secondary data. A total of 1966 patients who were treated with dental implants by participating dentists during the survey period were analysed. Among the total sample, 90 (5%) had early implant loss (≤12 months) and 153 (8%) had late implant loss (>12 months and ≤120 months). The number of pack-years was significantly higher in the total (early and late) implant loss group (31.2±15.9) than in the group with no implant loss (26.1±18.1) (P=0.026). In the multivariate analysis, the number of implants installed, smoking, and pack-years were significant factors for total implant loss. The adjusted odds ratio for implant failure for current smokers compared with never smokers was 2.07 (95% CI 1.19-3.62) for early implant loss and 1.48 (95% CI 0.92-2.37) for late implant loss. This study reaffirms that current smoking is associated with an increased risk of early implant loss, irrespective of the duration of smoking exposure.

The effectiveness of perioperative oral management in gastrointestinal surgery remains unclear. To elucidate the clinical significance of oral care, we investigated the relationship between the oral environment and postoperative infectious complications (POICs) in patients undergoing gastrointestinal surgery. This was a single-institute and historical cohort study of 341 patients. The participants were isolated from consecutive patients undergoing planned radical resection for gastrointestinal carcinoma from January 2016 to June 2017. Dentists assessed the oral environment for periodontal disease, hygiene status, dry mouth, fur on tongue, and tooth stumps. All patients received scaling and tooth brushing instructions. A stepwise logistic regression analysis was conducted to identify risk factors for POICs among the different oral statuses. The surgical procedures performed were gastrectomy in 123 (36.1%), colorectal resection in 185 (54.2%), and pancreatoduodenectomy or others in 38 (11.1%). POICs occurred in 48 patients (14.1%), including deep organ space infection in 20, surgical site infection in 11, anastomotic leakage in 5, urinary tract infection in 4, pneumonia in 2, and others in 6. After adjusting for confounding factors, periodontal disease was isolated as an independent risk factor for POICs (odds ratio 2.091, p = 0.037, 95% confidence interval 1.045–4.183). Other variables of oral environment such as hygiene status, dry mouth, fur on tongue, and tooth stumps did not have a significant impact on POICs. Periodontal disease is a risk factor for infectious complications after gastrointestinal surgery.

This study investigates selected predictors for clinical outcome of temporomandibular joint (TMJ) irrigation in patients with chronic closed lock (CCL).Fifty-six patients with unilateral CCL, who underwent a visually guided TMJ irrigation (VGIR), were enrolled in this study. They were divided into either successful (s-group; n = 38) or unsuccessful groups (u-group; n = 18), according to the clinical success criteria. The investigated predictive factors were age, gender, duration of symptoms before the VGIR, preoperative painless range of mandibular motion, preoperative self-evaluated TMJ pain on visual analog scale (VAS), severity of arthroscopically observed pathologies, and presence and concentrations of a set of pro- and anti-inflammatory cytokines (ie, tumor necrosis factor [TNF]-alpha, interleukin [IL]-1beta, IL-6, IL-8, IL-12, and IL-10) in the aspirated synovial fluid (A-SF). Several comparative analyses and logistic regression analyses were used for statistical studies.The preoperative VAS score, detection rate of IL-8, and concentrations of IL-6 and IL-8 in the A-SF were significantly higher in the u-group (P.05). Conversely, the detection rate and concentrations of IL-10 were significantly higher in the s-group (P.05). The multivariate adjusted odds ratio (OR) showed that the detectable IL-10 in the A-SF (OR, 10.882; P = .047) is significantly predictive for a successful VGIR.The presence of IL-10 in the A-SF is a significant predictor of successful outcome of TMJ irrigation for CCL. Severe TMJ pain and detectable IL-6 or IL-8 in the A-SF seem to indicate a poor outcome after TMJ irrigation.

The case of an isolated right submandibular gland aplasia, detected by computed tomography scan, magnetic resonance imaging, and technetium 99m-pertechnetate scintigraphy, in a 58-year-old man is reported.

Objective: To examine the feasibility of a combination of the blue dye injection method and reverse transcriptase-nested polymerase chain reaction for squamous cell carcinoma antigen mRNA to detect sentinel lymph node metastasis in patients with oral cancer. Patients and Methods: Ten individuals with previously untreated oral cancer participated in the study. Sentinel lymph nodes were identified by the blue dye injection method during neck dissection. We investigated the comparative effectiveness of frozen haematoxylin and eosin section analysis and molecular analysis of squamous cell carcinoma antigen for sentinel lymph node diagnosis. Results: In 8 out of the 10 cases, sentinel lymph nodes were identified. One histologically positive sentinel lymph node also showed positive for squamous cell carcinoma antigen. The remaining 7 histologically negative sentinel lymph nodes were also negative for squamous cell carcinoma antigen. However, in 3 cases, squamous cell carcinoma antigen-positive-non-sentinel lymph nodes were detected despite sentinel lymph nodes being negative for squamous cell carcinoma antigen. Conclusion: Our preliminary results suggest that the combination of the single blue dye injection method and reverse transcriptase-nested polymerase chain reaction for the squamous cell carcinoma antigen mRNA was not very accurate for detection of sentinel lymph node metastasis in patients with oral cancer.

Objective This study investigated the correlation of clinical outcomes of temporomandibular joint (TMJ) irrigation with the occurrence and concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-8, IL-12, and IL-10 in the washed-out synovial fluid (SF) in patients with chronic closed lock (CCL) of the TMJ. Study design Thirty-six patients underwent a visually guided TMJ irrigation (VGIR). SF samples were collected immediately before VGIR. The patients were divided into either successful (s-group; n = 25) or unsuccessful groups (u-group; n = 11). The detection rates and concentrations of each cytokine per milligram of total protein in the SF were measured, and then compared between the s- and u-groups. Results All of the investigated cytokines were detectable with various rates, concentrations, and combination patterns. The detection rate and concentrations of IL-6 were significantly higher in the u-group, and those of IL-10 were significantly higher in the s-group. Conclusions The investigated cytokines were suggested to be involved in the pathophysiology of TMJ CCL. The results also suggest that IL-6 in the SF is an indicator of an unsuccessful outcome, and that IL-10 is a significant predictor of a successful outcome of TMJ irrigation for CCL.

Objective This study aimed to explore the clinical course following visually guided irrigation (VGIR) for chronic closed lock (CCL) of the temporomandibular joint (TMJ) as well as the factors of importance for clinical outcome. Evaluation emphasis was placed on the period needed for the patients to reach the success criteria. Study design Sixty-one patients with unilateral CCL comprised the study group. The cumulative success rate of VGIR and the additional surgical treatments following VGIR were studied. The 61 patients were divided into either the good outcome (g) group or poor outcome (p) group on the basis of whether they reached the success criteria within 3 months postoperatively, and clinical and arthroscopic factors were correlated with the clinical outcome of VGIR. Results The cumulative success rate of VGIR increased up to the 6-month follow-up (success rate of 72.1%) but did not change after that point in time. A repeated VGIR (success rate of 87.5%) was performed in 8 patients. Open TMJ surgery (success rate of 87.5%) was performed in 8 patients, 7 of whom had an interfering condylar osteophyte. A pronounced reduction of preoperative painless range of mandibular motion (P-ROM) and advanced osteoarthritis (OA) were more frequently found in the p-group than in the g-group. The multivariate adjusted odds ratio showed that a decreased preoperative P-ROM was significantly predictive for a poor outcome of VGIR. Conclusions The efficacy of VGIR is clinically acceptable as an initial surgical treatment for TMJ CCL. A 6-month follow-up period ought to be sufficient for outcome assessment of VGIR. A pronounced reduction of preoperative P-ROM should be considered as a risk factor for delay of the postoperative improvement, and OA changes may sometimes affect the clinical outcome of VGIR.

We studied 1809 patients with oral cancer who visited and were treated in 2002 at the 148 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons, which comprise 39 dental university hospitals, 44 medical university hospitals, 64 general hospitals, and 1 unknown institution. The patients were 1071 (59.2%) males and 738 (40.8%) females (male: female ratio, 1.45: 1), who had a mean age of 65.2 years. The tongue (40.2%) was the most common site affected, followed by the gingiva (32.7%), buccal mucosa (10.1%), and oral floor (9.0%). There were 6 cases of intraoral multiple cancer. Histopathologically, squamous cell carcinoma (88.7%) was the most common type, followed by adenoid cystic carcinoma (2.1%), and mucoepidermoid carcinoma (1.7 %). Non-epithelial tumors comprised 1.8% of the total, among which malignant melanoma was the most common type. Cases classified as T2NO were the most common (32.1%), followed by T1NO (21.4%), T4NO (8.0%), and T2N1 (7.6%). Distant metastasis occurred in 17 patients (1.0%). The sizes of the non-epithelial malignant tumors ranged from 1.0 to 7.0cm, with a mean size of 3.7cm.

The authors report a case of cervical cellulitis and mediastinitis developing from odontogenic infection.A 52-year-old woman visited our clinic because of dyspnea and pain on swallowing. She was given a diagnosis of cervical cellulitis caused by an odontogenic infection of the lower left second and third molars. We administered antibiotics and extracted the lower left second and third molars. However, the patient's condition deteriorated, and the inflammation spread to the contralateral side. Four days later, surgical drainage of the left submental and submandibular regions was performed under general anesthesia.Despite this surgical procedure, a postoperative computed tomographic (CT) scan revealed anterosuperior mediastinitis and thrombosis extending from the right subclavian vein to the brachiocephalic vein. Therefore, transcervical mediastinal drainage, thrombolytic therapy, and placement of a vena cava filter were performed. Subsequently, the patient recovered uneventfully.Our experience indicates that it is important to accurately diagnose rapidly developing lesions and to promptly perform surgery when severe odontogenic infection is encountered.

We report a case of deep vein thrombosis occurred after mandibular reconstruction with a vascularized iliac bone graft. A 30-year-old man was referred to our clinic because of a right mandibular bone defect after segmental resection for ameloblastma of the mandible. Reconstruction with a vascularized iliac bone graft was performed with the patient under general anesthesia. On the 18th day after the operation, leg pain and edema on the left side suddenly occurred. Enhanced computed tomographic and angiographic examinations were performed. The diagnosis was deep vein thrombosis. The patient received heparin and urokinase as anticoagulant therapy and successfully recovered. There has been no evidence of pulmonary embolism.

Objective To evaluate the clinical outcome of a modified conservative treatment protocol involving intra-articular irrigation and corticosteroid injection into the superior joint compartment (SJC) of patients with fresh mandibular condyle fractures. Study design A total of 26 consecutive unilateral fresh condylar fractures in 26 patients were divided into the intra-articular irrigation (IR) group (14 patients, 14 joints) and the conventional conservative treatment (CC) group (12 patients, 12 joints). In the IR group, the SJCs of the fractured joints were irrigated with saline solution and injected dexamethazone sodium, followed by conventional rehabilitation. In the CC group, patients were treated by closed reduction with intermaxillary fixation (IMF) for 2 weeks, followed by conventional rehabilitation. Clinical outcome at 1 month, 3 months, 6 months, and 1 year after injury was determined by clinical examination of jaw motion, joint pain, and occlusal changes. The posttreatment results were compared with the pretreatment baseline data. Between-group differences in clinical parameters were analyzed. Results There were significant between-group differences in the range of mandibular motion at 1 month and 3 months after injury (1 month, P = .0022; 3 months, P = .0022). In the IR group, joint pain was well relieved from the early stage of treatment. Occlusal changes were found in 1 patient in the IR group and 4 patients in the CC group at 1 year after injury. Conclusions The modified treatment protocol involving intra-articular irrigation and corticosteroid injection into the SJC is a more effective and quick-acting modality than conventional closed reduction with IMF for functional recovery and control of clinical symptoms of patients with unilateral fresh condylar fractures.

A backward distraction osteogenesis (BDO) of the condylar segment for treatment of mandibular ramus deficiency was developed. This report describes the clinical progress of a patient with mandibular ramus deficiency in whom satisfactory occlusion was achieved and maintained by gradual posterosuperior repositioning of the displaced condyles into the glenoid fossae during intermaxillary fixation. Findings of pre- and postoperative clinical and magnetic resonance imaging indicate that the effect of BDO on the temporomandibular joint was negligible.

Lichen planus pemphigoides is a rare bullous disorder with bullae arising from papules of lichen planus and from normal-appearing skin. Oral cavity-limited lichen planus pemphigoides has never been reported. This report presents a 47-year-old woman who had oral mucous membrane pemphigoid with lichen planus. This lesion is not known among existing clinical diagnoses. When considering the heterogeneous nature of lichen planus pemphigoides, this case may be classified as a variant of lichen planus pemphigoides.

我々は頭頸部がん治療において機能回復を最終目標としている。そこで, 確実な原因療法が最重要であるが, 機能温存のために必要最小限の切除を考慮し機能回復に努めている。しかし, 生命医学, 機能回復医学の両面を一人で行うことは一般に困難であるため, 以下のようなチームが必要となる。1) 診断チーム2) 腫瘍治療チーム3) 機能回復チームまた, チームを編成する上で以下の点を考慮している。(1) 一人の指揮者がいること ; 様々な治療が常にこの指揮者にフィードバックされるようにし, 治療体制を見通す。(2) 各々の治療内容の理解。(3) 治療のブラックホールをつくらない。(4) 担当医同士の意思の疎通をよくする。(5) 目の前にいる患者に何ができるかを常に考える。(6) 執刀医を増やし積極的な討論を可能にする。現時点では口腔機能を回復したとは言い難いため, 関連各科が一緒になって取り組むことが不可欠である。また, 心のケアを考えていきたい。

Penetrating injuries, especially those involving the palate intraoral region, often occur in children. This is because when children begin to walk, their range of action increases but is unstable; moreover, children frequently play with something stuck in their mouth. Penetrating injuries of the facial region are rare. Many patients recover without brain trauma. We report a case of a penetrating injury of the facial region. A 4-year old girl fell down, and a pair of tweezers penetrated her left cheek and temple. The tweezers was used to feed tropical fish. She was taken to the emergency room without removal of the tweezers. Her consciousness was clear, but she had impaired movement of the left eye and a left-side nosebleed. After a radiographic examination, the tweezers were removed under a local anesthesia. The deep penetration caused cerebrospinal fluid leakage. The bleeding volume was small. The wound was compressed after being sutured. A computed tomographic scan showed no brain injury. Antibiotics were prescribed for several days. As of 22 months after injury, there have been no complications and the outcome is good.

Visually guided irrigation (VGIR) is simple joint irrigation with minimally invasive intracapsular inspection through the use of a thin arthroscope. The aims of the present study were to develop VGIR for the superior joint compartment of the temporomandibular joint (TMJ) by using a 1.2-mm-diameter rod-lens arthroscope and to examine the short-term clinical outcomes. The correlation between the clinical outcome of VGIR of the TMJ and intracapsular findings was also evaluated.Twenty patients who underwent VGIR for symptomatic internal derangement of the TMJ (n = 20) were enrolled in this study. The clinical outcome of VGIR was evaluated in terms of the improvement in the painless range of mandibular motion (ROM: interincisal distance in millimeters), and functional jaw pain was evaluated by using a visual analog scale (VAS) ranging from 0 to 100. Painless ROM and VAS scores 6 months postoperatively were compared with the preoperative data. A good clinical outcome was defined as an increased ROM (ROM38 mm) and a decreased VAS score (VAS score20%, and60% of the preoperative level). With respect to these criteria, all joints were classified into either good clinical outcome (GO) or poor clinical outcome (PO) groups. The difference in the distribution of the arthroscopic findings obtained during VGIR, with respect to severity, was analyzed between the GO and PO groups.None of the 20 patients experienced any serious local or systemic complications, including the breakage of instruments. We were able to perform a reliable intracapsular diagnosis during VGIR. Sixteen of 20 patients (80%) had significant improvements in postoperative painless ROM and the VAS score of functional pain, thereby being classified into the GO group. The distribution of the severity of intracapsular findings did not differ significantly between the GO group and the PO group.VGIR is useful for the treatment and diagnosis of internally deranged TMJs. These data suggest that the clinical outcome of TMJ irrigation is not related to the intracapsular condition of the superior joint compartment.

To improve the swallowing function of glossectomized patients with dysphagia after glossectomy, we newly fabricated a bolus-transportable palatal augmentation prosthesis (Trans-PAP), which is mounted with a bolus-transporting device to a conventional palatal augmentation prosthesis (PAP). In this paper, the structure of Trans-PAP is described and its clinical effectiveness for dysphagia in a patient undergoing subtotal glossectomy is reported.The patient was a 57-year-old man who underwent surgical reconstruction using a rectus abdominis myocutaneous flap immediately after subtotal glossectomy. Postoperative dysphagia was mainly caused by dysfunction of the pumping movement of the tongue. A Trans-PAP was applied. The bolus-transportation plate of Trans-PAP can press on the reconstructed tongue by spring action. Consequently, it is possible to compensate for tongue pressure and the pumping movement of the tongue. The results of functional examinations showed that swallowing function was restored by Trans-PAP.

Purpose: The goal of this study was to evaluate the clinical results of simple disc reshaping (SDR) surgery alone for treating dysfunctional internal derangement of the temporomandibular joint. Patients and Methods: Eleven patients with symptomatic unilateral anterior disc displacement with disc deformation were treated using reshaping of the inferior surface of the disc without disc repositioning. This was performed as an open-joint procedure. All patients were evaluated clinically for joint pain and jaw motion 5 years after surgery. Structural changes of the joint tissues such as disc displacement and deformation were evaluated using magnetic resonance imaging. The postoperative results were compared with preoperative findings. Results: Joint pain during mastication or opening was reported by all patients before surgery. In 10 of 11 patients (91%), the joint pain disappeared postoperatively. Preoperatively, all 11 patients had limitation of mouth opening: the mean opening was 24.9 mm (standard deviation [SD], 4.13 mm). Postoperatively, the mean opening increased to 43.0 mm (SD, 3.00 mm). Based on the preoperative magnetic resonance imaging, all cases were diagnosed as anterior disc displacement without reduction and with disc deformation. Five years postoperatively, the disc configuration had maintained the reshaped status with decreased thickness of the deformed disc in 5 patients, and was changed to an almost normal biconcave shape in 3 patients. In the remaining 3 patients, the disc was unchanged from its preoperative condition. The position of the disc was unchanged in 8 patients, and in 3 patients disc position improved to near normal. Conclusion: The 5-year follow-up results suggest that SDR is a stable and favorable surgical procedure. Successful outcomes were attained in 91% of the patients. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:41-48, 2003

We clinically observed patients treated between January 1999 and December 2001 at the department of oral and maxillofacial surgery after being brought by ambulance to a city emergency hospital. Of 11, 105 patients who were brought by ambulance during that period, 308 (2.8%) underwent oral or maxillofacial surgery. The male: female ratio was 2.1: 1, and more than half of the patients were younger than 30 years. There were 2 peaks in the age distribution: 2 and 21 years of age. Eighty-seven percent of the patients had traumasta such as lacerated wounds of soft tissue, alveolar bone fractures, and tooth luxation. Twenty-five of these patients (8.1%) required treatment under general anesthesia. Two patients with severe odontogenic infections underwent emergency surgery.Several of the patients who were brought to the hospital by ambulance required specialized oral and maxillofacial treatment.

Purpose: To investigate the use of a unique balloon catheter (sinus balloon) for maxillary sinus surgery, and to compare the clinical usefulness of this catheter to the conventional gauze pack with antibiotic ointment with respect to postoperative discomfort. Patients and Methods: 195 patients, who underwent Caldwell-Luc maxillary sinus surgery using the sinus balloon catheter were compared with 24 patients who underwent the same surgery using the gauze pack. Postoperative haemorrhage with the material in the sinus and haemorrhage at removal were evaluated. For 32 patients in the sinus balloon catheter group who had previously experienced maxillary sinus surgery using the gauze pack and 24 patients in the gauze pack group, pain at removal of the material was investigated by questionnaire. Results: There was no significant difference in the rate of postoperative haemorrhage between the 2 groups. The rates of haemorrhage and subjective pain level at removal of the material from the sinus were significantly lower for patients in the sinus balloon catheter group than for those in the gauze pack group. Twenty seven of 29 patients (93.1%) who completed the questionnaire preferred the sinus balloon catheter to the gauze pack. Conclusion: The sinus balloon catheter can reduce postoperative discomfort, and its compressive haemostatic effect is equal to that of the gauze pack. The sinus balloon is considered more clinically useful for maxillary sinus surgery than the gauze pack.

A 12-year-old boy with a bilateral cleft lip and alveolus underwent premaxillary osteotomy simultaneously to bilateral alveolar bone grafting and subsequent orthodontic tooth alignment. With a premaxillary osteotomy, the bone surface behind the premaxilla and posterior part of the alveolar cleft was sufficiently exposed for a wide graft bed to be successfully created. As a result of the grafting, postoperative orthodontic tooth alignment enabled completion of the maxillary dental arch without the need for a conventional dental prosthesis.

Objectives: The surgical accuracy of 2 external reference points when repositioning the osteotomised maxilla was analysed. Patients and Methods: In 31 patients undergoing Le Fort I osteotomy during orthognathic surgery, the intermediate splint and unoperated mandible was used to provide a horizontal maxillary position. In 14 patients, an external reference point marked on the forehead was taken to determine the maxillary vertical dimension (group I). In 17 patients, a miniplate screw placed into the frontal bone was used as an external reference point (group II). Preoperative lateral cephalograms were traced and superimposed onto the postoperative cephalograms to compare the preoperative, postoperative, and predicted position of the maxillary central incisor and the posterior nasal spine of each patient. The differences between predicted and actual changes in the maxillary central incisor and posterior nasal spine were calculated using the Frankfort horizontal plane as a reference. Results: Statistical analysis showed that an external reference pointplaced into the bone was a more reliable method of positioning the maxilla in the vertical dimension than a point marked on the skin ( p Conclusion: To improve surgical accuracy, surgeons must strive to reduce positional variance by careful treatment planning and precise surgery.

Chondroblastoma was first described by Jaffe and Lichtenstein in 19421 as a rare benign cartilaginous neoplasm that represents less than 1% of all bone tumors.2 Radiographically, the lesion typically presents as a round-to-ovoid expansive radiolucency. Microscopically, the tumor cells resemble chondroblasts, chondroid foci are frequently observed, and multinucleated giant cells are often present.2-4 Chondroblastomas typically arise in the bony epiphysis, with a predilection for the distal femur, proximal tibia, or proximal humerus. Those that are confined to the metaphysis occur less frequently.5 Approximately 20% of chondroblastomas affect the flat bones or the tubular bones of the hands and feet.6 The prognosis depends on whether the lesions have invaded the metaphysis, eroded the articular cartilage, or perforated into the adjacent joint space.2-4 Chondroblastomas that arise in the skull and facial bones are quite rare, and lesions in the mandibular condyle are even rarer.2,7-11

We devised a procedure for visually-guided irrigation (VGIR) of the superior joint compartment of the temporomandibular joint (TMJ) for the treatment of closed-lock and other TMJ diseases. A TMJ arthroscopy system using a 1.2-mm diameter rod-lens arthroscope was also developed to perform VGIR under local anesthesia. This paper introduces the arthroscopy system and VGIR procedure. The clinical applicability of VGIR is also discussed on the basis of the quality of arthroscopic findings obtained during VGIR and the incidence and course of complications associated with VGIR, including mechanical trouble.Eighty-five operations involving VGIR were studied. Arthroscopic findings obtained during VGIR were as clear as those obtained by using an arthroscope with a more than 2.0-mm diameter rod-lens, generally used for arthroscopic surgery. The following 7 complications were analyzed: 1) anesthetic trouble, 2) vascular injury, 3) perioperative discomfort, 4) neurological injury, 5) otological injury, 6) infection, 7) mechanical trouble. Complications occurred in 5 of the 85 (5.9%) operations. Two of the 5 complications were postoperative discomfort immediately after VGIR, 1 involved blood clots in the external auditory canal, and 2 were related to instrument breakage. However, no complication required specific treatment or interfered with the VGIR procedure.In conclusion, VGIR is useful clinically because that the procedure is minimally invasive, safe, and provides a highly reliable arthroscopic diagnosis.

当科における口蓋部を中心とした腫瘍切除に伴う再建, 補綴の方針を示す。(1) 硬口蓋, 歯槽部および軟口蓋前縁のみの欠損は, bulky な皮弁による再建は行わず, 義顎補綴を優先させる。(2) 広汎な軟口蓋を含む欠損は, 軟口蓋を血管柄付き遊離皮弁 (+骨付き) で再建し, 顎補綴のための欠損を残す。(3) 義顎は, 天蓋開放で軽量型とする。この原則に従い, 機能再建および補綴法を検討し施行している。また, 今回演者は簡便に術後機能を評価する方法として, OPS: Oral Performance Status を発案した。(結果) 1) 硬口蓋のみの欠損は, 義顎により良好な物理的閉鎖が得られ, ほとんどの患者で社会復帰も可能であった。2) 軟口蓋を含む欠損は, 皮弁で再建した上に義顎によって閉鎖しているが, 特に広汎な軟口蓋欠損症例では, 嚥下障害が残り, 十分な満足度は得られなかった。

Purpose: This study explored the morphologic changes and clinical symptoms related to the temporomandibular joint (TMJ) associated with long-term lack of mandibular continuity. Patients and Methods: The subjects were 20 patients (40 TMJs) who underwent mandibulectomy including the condyle or segmental mandibulectomy without mandibular reconstruction more than 6 months previous to the study. The 40 TMJs were classified into the following 3 groups: group I: TMJs with a major mandibular fragment including the mandibular body (n = 21), group II: TMJs with a minor mandibular fragment including only the condylar process or the mandibular ramus (n = 10), and group III: TMJs without a condyle (n = 9). All TMJs were examined with respect to disc position, condylar position, bony changes, and appearance of joint effusion on magnetic resonance imaging, as well as for the presence of joint or muscle pain and joint noise. Results: The rate of anterior disc displacement was 28.6% in group I, 10.0% in group II, and 100% in group III. All condyles in group I were located in the glenoid fossa. Seven of 10 condyles in group II were dislocated anteriorly out of the glenoid fossa. However, these condyles were situated in the intermediate zone of the disc. Osteoarthritic changes was found in 1 joint in group II. Joint effusion was not observed in group I. However, joint effusion was detected in the posterior region of the upper joint compartment in 7 of 10 TMJs in group II and in 8 of 9 TMJs in group III. In group II, the 7 TMJs with joint effusion were the same joints with anteriorly dislocated condyles. Clinical symptoms of TMJ pain, TMJ noise, or muscular pain were not found in any patients. Conclusions: Partial mandibulectomy does not affect the relationship between the disc and the condyle or the bony condition of the TMJ. The disc without a condyle will become anteriorly displaced with time. The condyle not connected to the mandibular body often dislocates anteriorly out of the glenoid fossa, while retaining a normal relationship with the disc. Joint effusion, which is detected in nonfunctional TMJs, is not associated with an inflammatory reaction in the joint compartment.

Purpose: This study evaluated the complications of temporomandibular joint (TMJ) arthroscopic lysis and lavage performed using the triangulation technique. Patients and Methods: The 202 consecutive patients (301 joints) who underwent arthroscopic lysis and lavage between 1992 and 1995 were retrospectively surveyed. The preoperative diagnosis of all patients was anterior disc displacement without reduction. Results: Complications were observed in 31 (10.3%) of 301 cases of arthroscopic lysis and lavage. Of these, otologic complications were found in 26 cases (8.6%): blood clots in the external auditory canal in 9; laceration of external auditory canal in 7; partial hearing loss in 5; ear fullness in 2; vertigo in 1; and perforation of tympanic membrane with laceration of external auditory canal in 1. Neurologic injuries were found in 5 cases (1.7%): fifth cranial nerve injuries in 3; and seventh cranial nerve injuries in 2. No other complications were observed. Conclusions: A high level of understanding of the regional anatomy helps reduce the complications associated with arthroscopic lysis and lavage in the TMJ.

Objective We histologically evaluated iliac particulate cancellous bone and marrow (PCBM) grafted to alveolar clefts in five young adults with cleft lip and palate. Patients and Methods Five young adults with cleft lip and palate underwent secondary alveolar bone grafting. The mean age of the patients was 21.2 years (range = 17 to 27 years). Bone specimens were taken from the graft site 5 to 10 months after the surgery simultaneously with implant fixture placement (two cases), vestibuloplasty (two cases), and rebone grafting (one case). These five bone specimens were prepared and stained with hematoxylin and eosin and examined microscopically. Result One specimen, taken 5 months after surgery, showed immature trabecular bone partially lined by osteoblasts. The remaining four specimens showed well-mineralized trabeculae and fatty change in the marrow space. Conclusion In young adult cases, PCBM remodeled after grafting and became mature bone about 5 to 6 months after the surgery.

根治手術後に即時再建手術を行った口底癌19症例の術後の構音機能と手術との関連性を分析した。評価方法は日本語100語音による発語明瞭度検査である。対象症例の内訳を軟組織の再建方法別にみると, 遊離前腕皮弁移植症例が12例, 大胸筋皮弁移植症例と腹直筋皮弁移植症例がそれぞれ3例, 前腕皮弁と大胸筋皮弁の併用症例が1例であった。舌の切除範囲別では, 舌部分切除症例が14例, 可動部半側切除症例が1例, 半側切除症例が1例, 亜全摘出症例が3例であった。これらの症例について原発腫瘍の大きさ, 切除範囲, 切除様式, 軟組織の再建方法, 下顎骨の再建方法と術後の構音機能の関連について検討した。その結果, 原発腫瘍の大きさによる術後の構音機能の差は少なかったが, 舌の切除範囲が大きくなると構音機能は低下していた。切除様式については側方型の切除を受けた症例の明瞭度は前方型の切除を受けた症例よりも明らかに高く, 切除様式による発音機能の差異が明らかであった。前方型の切除を行った症例の術後の発音障害を防ぐためには, 手術法の改善が必要であり補綴物の応用が有用であることが示唆された。

A 67-year-old man in apparent remission of malignant lymphoma had squamous cell carcinoma of the left buccal mucosa. The patient underwent partial resection of the mandible, including the excision of the tumor. During the fourth postoperative night the patient suddenly became febrile and had a spiking fever for the next 5 days. His general condition deteriorated afterward, and acute aggravation of malignant lymphoma was suspected. On day 16 disseminated intravascular coagulation was indicated by a decreased platelet count of 3.8 × 10 4 , a tendency toward bleeding, and multiple organ failure. The patient died 18 days postoperatively. We alert anesthesiologists and surgeons that surgically treating patients with malignant lymphoma who are receiving immunosuppressive drugs is precarious even though their disease is considered to be in apparent remission.

In this report, the MRI and arthroscopic findings in the temporomandibular joint (TMJ) of two patients who underwent partial mandibulectomy including the condyle are presented. The disc and superior joint compartment of the affected TMJs were preserved in both patients. MRI of the affected TMJs without condyle demonstrated that the intermediate zone of the discs was located anteriorly to the summit of the articular eminence. Joint effusion was detected in the superior joint compartment of one patient. Fibrous adhesions were observed arthroscopically in the superior joint compartment of both affected TMJs. In contrast, no specific findings were demonstrated in the contralateral TMJs connected with the residual mandibular fragment.

This report describes a patient who underwent two-jaw osteotomy with simultaneous reconstructive surgery of the temporomandibular joint (TMJ) using an autologous costochondral graft. The patient had skeletal malocclusion and facial asymmetry caused by dislocation and resorption of the condyle associated with a previous fracture. We planned the operation to prevent a postoperative continuous decrease in ramus height. Postoperatively, the provision of posterior support for the decreased ramus height was useful in maintaining stable occlusion and facial asymmetry. There was no postoperative ankylosis of the TMJ, and the grafted cartilage-bone complex underwent remodeling physiologically.We conclude that costicartilage is a suitable material for TMJ reconstruction and maintaining ramus height.

A case of nonclostridial gas-producing phlegmon in the mouth floor and neck of a young healthy patient is reported. A 24-year-old man had swelling and pain on the right submandibular region. Two days before admission to our hospital, he had pain and swelling of right lower molar region. On the next day, a swelling and spontaneous pain developed at the right submandibular region with pyrexia after 6 had been extracted by the patient himself. A clinical diagnosis of oral floor phlegmon was made. Antibiotic treatment was initiated intravenously. Three days later, he complained of dyspnea. Computed tomography (CT) revealed extension of gas bubbles in the soft tissue. Emergency tracheostomy and surgical drainage were performed. He recovered uneventfully and was discharged after 45 days.Early detection of gas bubbles by CT, complete surgical drainage and administration of antibiotics are considered the most important factors in treating gas-producing phlegmon.

Objective This study aimed to investigate the changes of joint effusion (JE) on the MRI and arthroscopically observed pathology after visually guided TMJ irrigation (VGIR) in patients with chronic closed lock. The correlation of these findings to the clinical outcome was also studied. Study design Forty patients with unilateral chronic closed lock who underwent 2-time VGIR, were divided into either the good outcome (g-) group (n = 29) or poor outcome (p-) group (n = 11) after the first VGIR. Before each VGIR, the each severity of JE, osteoarthritis, synovitis, and fibrous adhesion were assessed. They were compared between the g- and p-groups, or between the first and second VGIR. Results The severity of JE at the first VGIR was significantly worse in the p-group. In both groups, JE significantly improved after the first VGIR. In the g-group, synovitis significantly improved after the first VGIR, but fibrous adhesion significantly became worse. Conclusions JE may be predictive for the clinical outcome of TMJ irrigation in chronic closed lock patients. Moreover, the severity of JE and arthroscopically observed synovitis could reflect the clinical state to some degree.

We studied 1809 patients with oral cancer who visited and were treated, in 2002, at the 148 institutions certified as training facilities by the Japanese Society of Oral and Maxillofacial Surgeons. Of these institutions, 39 are dental university hospitals, 44 are medical university hospitals, 64 are general hospitals, and for 1 institution, the classification was not known. The patients consisted of 1071 (59.2%) males and 738 (40.8%) females (male: female ratio, 1.45:1), who had a average age of 65.2 years. The tongue (40.2%) was the most common site affected, followed by the gingiva (32.7%), buccal mucosa (10.1%), and oral floor (9.0%). There were 6 cases of multiple intraoral cancers. On histopathological examinations, squamous cell carcinoma (88.7%) was the most common type found, followed by adenoid cystic carcinoma (2.1%), and mucoepidermoid carcinoma (1.7%). Cases classified as T2N0 were the most common (32.1%), followed by T1N0 (21.4%), T4N0 (8.0%), and T2N1 (7.6%). Distant metastasis occurred in 17 patients (1.0%). Nonepithelial tumors, among which malignant melanoma was the most common type, accounted for 1.8% of the tumors. The sizes of the nonepithelial malignant tumors ranged from 1.0 to 7.0 cm, with an average size of 3.7 cm.

Objective This study aimed to investigate the severity of arthroscopically observed pathologies and the levels of a set of inflammatory cytokines in aspirated synovial fluid (A-SF) in patients with chronic closed lock (CCL) of the temporomandibular joint (TMJ) before and after visually guided TMJ irrigation (VGIR). Furthermore, the findings were correlated with the clinical outcome after VGIR. Study design VGIR was performed in 56 consecutive patients with unilateral CCL. Forty-nine of them, who underwent a second VGIR either as a follow-up arthroscopy or as a repeated therapeutic irrigation, were analyzed. They were assigned to either the successful (s-) group (n = 31) or unsuccessful (u-) group (n = 18), according to the clinical success criteria. The severity of arthroscopic findings of osteoarthritis (OA), synovitis, and fibrous adhesion (FA) were evaluated as arthroscopic scores. The levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-8, IL-12, and IL-10 in the A-SF were measured. At the first and second VGIR, the arthroscopic scores and the levels of each investigated cytokine were compared between the s- and u-groups. In each group, same parameters were compared between the first and second VGIR. Results At the first and second VGIR, there are no differences in the arthroscopic scores between the s- and u-groups. After the first VGIR, the severity of synovitis significantly improved, that of OA was unchanged, and that of FA became worse in the s- and u-groups. At the first VGIR, the levels of IL-6 and IL-8 were significantly higher in the u-group, and the IL-10 level was significantly higher in the s-group. At the second VGIR, however, there were no differences in the levels of each investigated cytokine between the s- and u-groups. The levels of each cytokine did not significantly change between the first and second VGIR, regardless of the clinical outcome. Conclusions VGIR may contribute to the remission of synovitis in patients with TMJ CCL. However, the severity of arthroscopically observed pathologies and the levels of each investigated cytokine do not seem to be reflected by the clinical state. Moreover even if the intra-articular inflammation is asymptomatic, an exacerbation may not be ruled out even after a successful VGIR.

Epithelial-myoepithelial carcinoma (EMC) is a rare low-grade malignant salivary gland neoplasm typically found in the parotid gland. This report describes a case of EMC that arose from the submandibular gland, and gives special emphasis to the preoperative diagnostic value of positron emission tomography (PET) in combination with computed tomography (CT) and magnetic resonance imaging (MRI). Although a preoperative diagnostically specific image of EMC could not be established, the malignant nature of this tumor was detected by these combined examinations.

Osteoblastoma arises primarily in the vertebral column, limbs, and other long tubular bones. It rarely occurs in the jaws.This report describes a 22-year-old woman who visited our department because of swelling and pain at 3 2. Intraoral examination revealed marked pain on percussion at 3 2 with turgescence on the lingual side. Radiographic examination showed sequestrum-like findings with the presence of both radiopaque and radiolucent areas.Under local anestesia, 3 2 were extracted and the tumor was extirpated en bloc. Pathological examination suggested that the lesion was an osteoblastoma. The patient's postoperative course is favorable as of 41 months after the operation.

We report a case of candidiasis occurring in the maxillary sinus.The patient was a 53-year-old woman who presented with a major complaint of a strange feeling of the right cheek. Computed tomographic examination revealed an opaque, softtissue-like mass in the right maxillary sinus, which contained a high-density region. The clinical diagnosis was right chronic maxillary sinusitis accompanied by a foreign body in the maxillary sinus.Caldwell-Luc operation was performed under general anesthesia. Caseous material was found in the sinus, and it was removed. The postoperative histopathological diagnosis was candidiasis. Three years have passed since operation, and the patient's progress has been good.

We report a case of synovial osteochondoromatosis localized in the upper joint compartment of the right side of the TMJ. A calcified nodular lesion was detected on arthrography CT, and MRI.The lesion was extirpated by arthroscopic surgery.